Since first described 30 years ago, research suggests that thunderstorm asthma events result from a complex interaction of environmental factors and individual susceptibility factors. Environmental factors include:

To mitigate future risk, education is necessary at all levels of health care (from primary care to government), particularly directed at those with seasonal rhinitis. Further research is required to fully understand the pathophysiological signs that may predispose or prime the lung to be triggered by an environmental event.

What is known about the population risk?

Depending on the size of the population at risk, thunderstorm-associated asthma outbreaks may overwhelm the capacity of health services, as happened in Melbourne, London and Wagga Wagga. Melbourne has suffered recurrent outbreaks, with the first Australian report in 1984, and subsequent epidemics of increasing severity in 1987, 1989, 2003 and 2010. The unique topography predisposing to this vulnerability includes widespread rye grass pastures immediately north of the Great Dividing Range, with seasonal thunderstorm weather and hot northerly winds delivering potent allergenic triggers to a concentrated and susceptible urban population.

Rhinitis and asthma: “one airway, one disease”

Allergic rhinitis is a global health problem. In one Australian study, 42% of participants reported significant work or school interference because of symptoms. Most patients with asthma have rhinitis, leading to the concept of “one airway, one disease”.

The event in Melbourne underlines the importance of thoroughly understanding the severity and duration of rye grass pollen rhinitis as a risk factor for thunderstorm asthma. It also highlights the importance of education of patients on how vital it is that those at risk carry a reliever inhaler in the event of an unexpected asthma attack.

Significant effort at all levels (for patients and medical professionals) needs to be implemented to avert a further catastrophic event. This may include a “Sneeze! Wheeze! Think asthma!” advertising campaign targeting those with seasonal rhinitis in addition to those with known seasonal asthma and urging an annual GP review early in spring.

Bruce Thompson is professor of Allergy, Immunology and Respiratory Medicine at the Central Clinical School, Monash University and Alfred Health, in Melbourne.

Robyn E O’Hehir is professor of Allergy, Immunology and Respiratory Medicine at the Central Clinical School, Monash University and Alfred Health, Melbourne.

Professor Michael J. Abramson is with the School of Public Health and Preventive Medicine, at Monash University, in Melbourne.

Francis Thien is professor of Respiratory Medicine at Eastern Health and Monash University, in Melbourne.

To find a doctor, or a job, to use GP Desktop and Doctors Health, book and track your CPD, and buy textbooks and guidelines, visit doctorportal.

One thought on “Thunderstorm asthma: one airway, one disease”

This should not be a binary decision- the poll is not representative of the choices that should be available. International best practice in organ donation does not work this way. Spain for example has no register and asks every family- they are expert at what they do and do not blame families or bully their communities.